DXA Bone Scan — Diagnosed or Significant Risk for Low Bone Mineral Density — Clinical Pathway: Inpatient, Outpatient Specialty Care and Primary Care

Bone Density Scan (DXA) Clinical Pathway — Outpatient Specialty Care and Primary Care

Diagnosed with or High Risk for Bone Disease

Children with diagnosed or suspected bone disease are at significant risk for low bone mineral density. Children may benefit from referral to bone health specialist and/or treatment.

DXA evaluation and monitoring should be strongly considered for:

Diagnosis Key Points DXA Recommendations
Clinically Significant Fractures
  • ≥ 2 long bone fractures by age 10 yrs
  • or
  • ≥ 3 long bone fractures at any age up to 19 yrs
  • or
  • Vertebral compression fracture
  • Screening DXA
  • Follow up as indicated by Z-score
Idiopathic Juvenile Osteoporosis
  • This is rare in children and adolescents
  • May be diagnosed on X-ray and confirmed via
    DXA scan
  • Most children achieve complete recovery
  • DXA scan every 12 mos until recovery
Osteogenesis Imperfecta (OI)
  • DXA scans may help assess skeletal fragility
    and development
  • Follow-up scans recommended to assess the effects of treatment (bisphosphonate therapy)
  • DXA scan before starting treatment
  • Repeat scan every 6-12 mos

Adapted from 2019 PEDS–ISCD Position Statement   and the 2016 AAP Guidelines for DXA Scans  

Clinically Significant Fractures

  • Healthy children often fracture bones
  • A clinically significant fracture is defined as a fracture that occurs without trauma (atraumatic) or after minimal trauma (low-impact fracture)
  • Clinically significant fractures are further identified as vertebral or non-vertebral
Type of Fracture Comments
Vertebral
  • Usually occurs without trauma and is an important indication of bone fragility
  • Asymptomatic, often overlooked
  • Common in young children with leukemia, OI, steroid exposure
  • Can be diagnosed: AP and lateral spine X-ray
Non-vertebral
  • Occurs in arms and legs
  • ≥ 2 long bone fractures by age 10 yrs
  • ≥ 3 long bone fractures at any age up to 19 yrs
  • Lower extremity fractures common in immobilized children